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Nearly half of Ghanaians in a poll conducted by The Weekend Globe have had to pay cash for medical services they know their National Health Insurance Scheme card should cover. According to the survey, which was done in partnership with mobile-polling and research firm VOTO mobile, about 43 percent of Ghanaians with the card have had to pay cash for NHIS-covered treatments. One in four Ghanaians-or about twenty five percent of respondents said they had their cards rejected by both government and private hospitals that were supposed to accept their health insurance card. Of those people who had their cards rejected, almost 60 percent said they ended up paying cash for services that the card should have paid for. �I went to Okomfo Anokye hospital for an x-ray scan and when I presented my insurance card, it was rejected,� one female respondent told The Weekend Globe in a part of the survey where respondents could anonymously describe their experiences. �They didn�t tell me why. My sister also went there with her card for a different treatment and her car was also rejected. Over the years, Ghana�s National Health Insurance Scheme (NHIS) has come under a lot of public scrutiny following what some have described as a failing plan instituted under the erstwhile Kufuor administration. The aim of the scheme was to abolish what was then described as the �cash and carry� system of health delivery, where one had to pay money at every point of treatment for health services are delivered. The new scheme is meant to benefit Ghana�s poor and vulnerable, who may not otherwise be able to afford access to crucial medical services. But it is clear from responses to this exclusive survey that there remain many serious problems with the current system. NHIS cards are regularly being rejected by hospitals and ordinary Ghanaians are being forced to pay for essential medical services. At the same time, the poll reveals that the majority of Ghanaians with an NHIS card do not understand what treatments the card can be used for, while those who do not have a card report a lack of knowledge as a key reason for not having a card. Most Ghanaians (37%) responded that they do not think Ghana�s health insurance scheme is working effectively, while about 23% thought the scheme could be improved. About 33% of respondents thought the NHIS was working effectively.